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Students Taking A Right Stand (STARS) Nashville Student Assistance Program

The Students Taking A Right Stand (STARS) Nashville Student Assistance Program (SAP) is based on an employee assistance model and provides comprehensive school-based prevention services for students in kindergarten through 12th grade. Service components of the program include health promotion for the general student body; attention to students who are at special risk for substance abuse, teen pregnancy, violence/bullying, academic failure, school suspension, or dropping out; and early problem identification, referral, and intervention for students exhibiting problem behaviors.

The intervention is administered through SAP specialists who are placed at the school sites on a full- or part-time basis and work with faculty teams and student leaders to develop health promotion topics and activities tailored to meet the needs of students. The SAP specialists provide all students with prevention education (e.g., through assemblies and classroom presentations), emphasizing the establishment of prosocial norms and the building of protective factors, as well as information on overcoming social and emotional barriers to learning. They also provide counseling to small groups and individuals, linking these students to additional appropriate services in the school and community (e.g., mental health and substance abuse treatment services). SAP specialists must have at least a bachelor's degree in psychology, sociology, education, or a related field of study (a master's degree is preferred) and a minimum of 2 years of experience working with youth.

Participants in the studies reviewed for this summary were middle school and high school students (grades 6-12) in Middle Tennessee.

Descriptive Information

Areas of Interest Mental health promotion
Substance abuse prevention
Outcomes Review Date: August 2011
1: Substance use and abuse
2: Attitudes toward drugs
3: School values
4: Social attitude and social bonding
5: Rebellious and violent attitudes
Outcome Categories Alcohol
Drugs
Social functioning
Ages 6-12 (Childhood)
13-17 (Adolescent)
Genders Male
Female
Races/Ethnicities Black or African American
Hispanic or Latino
White
Race/ethnicity unspecified
Settings School
Geographic Locations Urban
Suburban
Rural and/or frontier
Implementation History Since 1984, the STARS Nashville SAP has been implemented at 120 sites in the Nashville/Middle Tennessee area and at 95 sites in southeast Tennessee. Additionally, over 25,000 schools and school districts across the United States use portions of the STARS Nashville SAP model and materials. STARS Nashville has provided student assistance services to over 1 million students since 1984.
NIH Funding/CER Studies Partially/fully funded by National Institutes of Health: No
Evaluated in comparative effectiveness research studies: No
Adaptations No population- or culture-specific adaptations of the intervention were identified by the developer.
Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories Universal
Selective
Indicated

Quality of Research
Review Date: August 2011

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

Hepler, N., Williams, C., Butler, D., & Cook, P. (1998, October). Community Based-TADPOLE agency evaluations--Annual reports to agencies: Fiscal year 97/98. Memphis, TN: University of Memphis.

Study 2

Hepler, N., & Williams, C. (2002). Interpreting and applying the Community Based-TADPOLE report: Fiscal year 2001-2002. Memphis, TN: University of Memphis.

Study 3

Williams, C. (2003). Community Based-TADPOLE control group study report: 2003 (Technical report prepared for STARS). Memphis, TN: University of Memphis.

Supplementary Materials

Dinwiddie, R., Davis, S., Diffenderfer, T., & Hepler, N. (2003). Excerpts from Students Taking A Right Stand Student Assistance Program STARS SAP fidelity of implementation report (Report submitted to the Substance Abuse and Mental Health Services Administration). Nashville, TN: STARS Nashville.

Hepler, N., & Kanu, M. (2011). A summary of research methods for the University of Memphis Tennessee Alcohol and Drug Prevention Outcome Longitudinal Evaluation (TADPOLE).

Hepler, N., Kanu, M., & Williams, C. (2009). Assessing effectiveness of Students Taking A Right Stand (STARS) programs: A case study of 14 years (SY94-95 through SY0809) of evaluations of the STARS program in Nashville, TN.

Okerson, B. B., & Quaranta, P. C. (1996, March). TADPOLE: An application for evaluation of the state of Tennessee's alcohol and drug prevention program using the SAS system. Poster presented at the 21st annual SAS Users Group International Conference, Chicago, IL.

Outcomes

Outcome 1: Substance use and abuse
Description of Measures Substance use and abuse were assessed using the Student Attitudinal Inventory, a self-administered, paper-and-pencil survey that includes both attitudinal and behavioral dimensions:

  • The attitudinal dimensions measure risk and protective factors: positive social attitude and social bonding; self-esteem; value attachment to school and school bonding; rebelliousness (violence); and attitudes unfavorable toward drug use and experimentation.
  • The behavioral dimensions measure alcohol, tobacco, and other drug use: gateway drug use; smokeless tobacco use; and drug abuse, including getting drunk on alcohol.
Key Findings Participants in all three studies were middle and high school students in Tennessee.

In one study, pre- and posttest data from the students who received the STARS Nashville SAP were compared with mean student data from all State-funded drug prevention programs that provided services to students in the same region as the SAP (norm comparative group). From pre- to posttest, SAP participants had a greater decrease in gateway drug use (p < .001) and drug abuse (p < .05) relative to students in the norm comparative group. In addition, data from SAP participants were compared with a growth curve model. The growth curve model is a statistical control group that uses matched group pretest data to construct age-related posttest data, which can be used to predict what the no-treatment effect would have been for participants if they had not received the intervention. From pre- to posttest, SAP participants had a greater decrease in gateway drug use (p < .05) and drug abuse (p < .05) relative to the growth curve model.

In a second study, data from STARS Nashville SAP participants were compared with a growth curve model. From pre- to posttest, SAP participants had a decrease in gateway drug use relative to the growth curve model (p < .05).

In a third study, participants were randomly assigned to the intervention group, which received the STARS Nashville SAP, or the wait-list control group. From pre- to posttest, participants in the intervention group had a decrease in drug abuse (p < .05), and those in the control group had an increase in drug abuse (p < .05); the between-group difference was statistically significant (p = .03). In addition, data from the SAP participants were compared with a growth curve model. From pre- to posttest, participants in the intervention group had a decrease in drug abuse relative to the growth curve model (p < .05).
Studies Measuring Outcome Study 1, Study 2, Study 3
Study Designs Experimental, Quasi-experimental
Quality of Research Rating 2.6 (0.0-4.0 scale)
Outcome 2: Attitudes toward drugs
Description of Measures Attitudes toward drugs were assessed using the Student Attitudinal Inventory, a self-administered, paper-and-pencil survey that includes both attitudinal and behavioral dimensions:

  • The attitudinal dimensions measure risk and protective factors: positive social attitude and social bonding; self-esteem; value attachment to school and school bonding; rebelliousness (violence); and attitudes unfavorable toward drug use and experimentation.
  • The behavioral dimensions measure alcohol, tobacco, and other drug use: gateway drug use; smokeless tobacco use; and drug abuse, including getting drunk on alcohol.
Key Findings Participants in all three studies were middle and high school students in Tennessee.

In one study, pre- and posttest data from the students who received the STARS Nashville SAP were compared with mean student data from all State-funded drug prevention programs that provided services to students in the same region as the SAP (norm comparative group). From pre- to posttest, SAP participants and students in the norm comparative group had an increase in healthy attitudes toward drug use (i.e., attitudes unfavorable toward drug use and experimentation) (p < .05 for each group). In addition, data from SAP participants were compared with a growth curve model. The growth curve model is a statistical control group that uses matched group pretest data to construct age-related posttest data, which can be used to predict what the no-treatment effect would have been for participants if they had not received the intervention. From pre- to posttest, SAP participants had an increase in healthy attitudes toward drugs relative to the growth curve model (p < .05).

In a second study, data from STARS Nashville SAP participants were compared with a growth curve model. From pre- to posttest, SAP participants had an increase in healthy attitudes toward drugs relative to the growth curve model (p < .05).

In a third study, participants were randomly assigned to the intervention group, which received the STARS Nashville SAP, or the wait-list control group. From pre- to posttest, participants in the intervention group had an increase in healthy attitudes toward drugs relative to those in the control group (p < .05). In addition, data from SAP participants were compared with a growth curve model. From pre- to posttest, participants in the intervention group had an increase in healthy attitudes toward drugs relative to the growth curve model (p < .05).
Studies Measuring Outcome Study 1, Study 2, Study 3
Study Designs Experimental, Quasi-experimental
Quality of Research Rating 2.6 (0.0-4.0 scale)
Outcome 3: School values
Description of Measures School values were assessed using the Student Attitudinal Inventory, a self-administered, paper-and-pencil survey that includes both attitudinal and behavioral dimensions:

  • The attitudinal dimensions measure risk and protective factors: positive social attitude and social bonding; self-esteem; value attachment to school and school bonding; rebelliousness (violence); and attitudes unfavorable toward drug use and experimentation.
  • The behavioral dimensions measure alcohol, tobacco, and other drug use: gateway drug use; smokeless tobacco use; and drug abuse, including getting drunk on alcohol.
Key Findings Participants in all three studies were middle and high school students in Tennessee.

In one study, pre- and posttest data from the students who received the STARS Nashville SAP were compared with mean student data from all State-funded drug prevention programs that provided services to students in the same region as the SAP (norm comparative group). From pre- to posttest, SAP participants had a greater increase in school values (i.e., value attachment to school and school bonding) relative to students in the norm comparative group (p < .05). In addition, data from SAP participants were compared with a growth curve model. The growth curve model is a statistical control group that uses matched group pretest data to construct age-related posttest data, which can be used to predict what the no-treatment effect would have been for participants if they had not received the intervention. From pre- to posttest, SAP participants had an increase in school values relative to the growth curve model (p < .05).

In a second study, data from STARS Nashville SAP participants were compared with a growth curve model. From pre- to posttest, SAP participants had an increase in school values relative to the growth curve model (p < .05).

In a third study, participants were randomly assigned to the intervention group, which received the STARS Nashville SAP, or the wait-list control group. From pre- to posttest, participants in the intervention group had an increase in school values relative to the control group, which had a decrease in school values (p < .05). In addition, data from SAP participants were compared with a growth curve model. From pre- to posttest, participants in the intervention group had an increase in school values relative to the growth curve model (p < .05).
Studies Measuring Outcome Study 1, Study 2, Study 3
Study Designs Experimental, Quasi-experimental
Quality of Research Rating 2.6 (0.0-4.0 scale)
Outcome 4: Social attitude and social bonding
Description of Measures Social attitude and social bonding were assessed using the Student Attitudinal Inventory, a self-administered, paper-and-pencil survey that includes both attitudinal and behavioral dimensions:

  • The attitudinal dimensions measure risk and protective factors: positive social attitude and social bonding; self-esteem; value attachment to school and school bonding; rebelliousness (violence); and attitudes unfavorable toward drug use and experimentation.
  • The behavioral dimensions measure alcohol, tobacco, and other drug use: gateway drug use; smokeless tobacco use; and drug abuse, including getting drunk on alcohol.
Key Findings Participants in all three studies were middle and high school students in Tennessee.

In one study, pre- and posttest data from the students who received the STARS Nashville SAP were compared with mean student data from all State-funded drug prevention programs that provided services to students in the same region as the SAP (norm comparative group). From pre- to posttest, SAP participants and students in the norm comparative group had an increase in positive social attitude and social bonding (p < .05). In addition, data from SAP participants were compared with a growth curve model. The growth curve model is a statistical control group that uses matched group pretest data to construct age-related posttest data, which can be used to predict what the no-treatment effect would have been for participants if they had not received the intervention. From pre- to posttest, SAP participants had an increase in positive social attitude and social bonding relative to the growth curve model (p < .05).

In a second study, data from STARS Nashville SAP participants were compared with a growth curve model. From pre- to posttest, SAP participants had an increase in positive social attitude and social bonding relative to the growth curve model (p < .05).

In a third study, participants were randomly assigned to the intervention group, which received the STARS Nashville SAP, or the wait-list control group. From pre- to posttest, SAP participants and those in the wait-list control group had an increase in positive social attitude and social bonding (p < .05). In addition, data from SAP participants were compared with a growth curve model. From pre- to posttest, participants in the intervention group had an increase in positive social attitude and social bonding relative to the growth curve model (p < .05).
Studies Measuring Outcome Study 1, Study 2, Study 3
Study Designs Experimental, Quasi-experimental
Quality of Research Rating 2.6 (0.0-4.0 scale)
Outcome 5: Rebellious and violent attitudes
Description of Measures Rebellious and violent attitudes were assessed using the Student Attitudinal Inventory, a self-administered, paper-and-pencil survey that includes both attitudinal and behavioral dimensions:

  • The attitudinal dimensions measure risk and protective factors: positive social attitude and social bonding; self-esteem; value attachment to school and school bonding; rebelliousness (violence); and attitudes unfavorable toward drug use and experimentation.
  • The behavioral dimensions measure alcohol, tobacco, and other drug use: gateway drug use; smokeless tobacco use; and drug abuse, including getting drunk on alcohol.
Key Findings Participants in all three studies were middle and high school students in Tennessee.

In one study, pre- and posttest data from the students who received the STARS Nashville SAP were compared with mean student data from all State-funded drug prevention programs that provided services to students in the same region as the SAP (norm comparative group). From pre- to posttest, SAP participants had a greater decrease in rebellious and violent attitudes relative to students in the norm comparative group (p < .02). In addition, data from SAP participants were compared with a growth curve model. The growth curve model is a statistical control group that uses matched group pretest data to construct age-related posttest data, which can be used to predict what the no-treatment effect would have been for participants if they had not received the intervention. From pre- to posttest, SAP participants had a decrease in rebellious and violent attitudes relative to the growth curve model (p < .05).

In a second study, data from STARS Nashville SAP participants were compared with a growth curve model. From pre- to posttest, SAP participants had a decrease in rebellious and violent attitudes relative to the growth curve model (p < .05).

In a third study, participants were randomly assigned to the intervention group, which received the STARS Nashville SAP, or the wait-list control group. From pre- to posttest, participants in the intervention group and those in the wait-list control group had a decrease in rebellious and violent attitudes (p < .05); the between-group difference was statistically significant (p = .03). In addition, data from SAP participants were compared with a growth curve model. From pre- to posttest, participants in the intervention group had a decrease in rebellious and violent attitudes relative to the growth curve model (p < .05).
Studies Measuring Outcome Study 1, Study 2, Study 3
Study Designs Experimental, Quasi-experimental
Quality of Research Rating 2.6 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study Age Gender Race/Ethnicity
Study 1 6-12 (Childhood)
13-17 (Adolescent)
60% Female
40% Male
74% White
21% Black or African American
5% Hispanic or Latino
Study 2 6-12 (Childhood)
13-17 (Adolescent)
58% Female
42% Male
74% White
20% Black or African American
6% Hispanic or Latino
Study 3 6-12 (Childhood)
13-17 (Adolescent)
58% Female
42% Male
71% White
22% Black or African American
7% Race/ethnicity unspecified

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

  1. Reliability of measures
  2. Validity of measures
  3. Intervention fidelity
  4. Missing data and attrition
  5. Potential confounding variables
  6. Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome Reliability
of Measures
Validity
of Measures
Fidelity Missing
Data/Attrition
Confounding
Variables
Data
Analysis
Overall
Rating
1: Substance use and abuse 3.5 3.0 2.0 3.0 2.0 2.0 2.6
2: Attitudes toward drugs 3.5 3.0 2.0 3.0 2.0 2.0 2.6
3: School values 3.5 3.0 2.0 3.0 2.0 2.0 2.6
4: Social attitude and social bonding 3.5 3.0 2.0 3.0 2.0 2.0 2.6
5: Rebellious and violent attitudes 3.5 3.0 2.0 3.0 2.0 2.0 2.6

Study Strengths

The Student Attitudinal Inventory has good reliability, with Cronbach's alpha coefficients ranging from .80 to .88 and a mean alpha coefficient of .83. Field research in Canada, the United Kingdom, and the United States has shown the instrument to have acceptable validity when used with school-aged children and adolescents. Study documents indicate that annual training was provided to the STARS Nashville SAP specialists, training was provided to new personnel working with the STARS Nashville SAP, the STARS Nashville SAP was delivered by counselors, and referrals were provided by school personnel, all of which help to ensure intervention fidelity. In addition, program managers conducted site visits for fidelity of implementation. The studies used fidelity instruments with acceptable psychometric properties. The researchers accounted for missing data through the use of a mean imputation technique for survey questions not answered by individual students. Pre- and posttest matching was based on demographics, and quality control of surveys was conducted with a computer and manually to minimize the loss of pre- and posttest matches. Attrition rates across the three studies were low to moderate (17%, 22%, and 7%) and were accounted for in the matching process.

Study Weaknesses

Although study documents mentioned items that help to ensure intervention fidelity, it was difficult to determine the level and quality of intervention fidelity; for example, the documents did not mention evidence of judgments by experts, systematic collection of data for dosage, time spent in training, or adherence to guidelines. Across the studies, potential confounding variables are a concern (e.g., data were collected by school personnel, not the researchers; differences in the study population were not adequately taken into account). In addition, two of the studies did not use an adequate control group. Study documentation did not provide sufficient evidence to rule out the possibility of a type III error (i.e., incorrectly inferring the direction of the effect). Analyses did not account for a number of psychosocial variables correlated with adolescent substance use or abuse (e.g., violent and sexual risk-taking behavior), resulting in concerns regarding the control of type I errors (i.e., false-positive results).

Readiness for Dissemination
Review Date: August 2011

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Program Web site, http://www.starsnashville.org/

SAP 101

STARS Student Assistance Program Trainer's Agenda and Manual

STARS Training and Implementation Manual

Student Assistant Program Training: Participant Workbook

Student Assistant Programs: Building the Bridge Between Schools, Families and Communities [PowerPoint slides]

Other implementation materials, training materials, and quality assurance procedures

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

  1. Availability of implementation materials
  2. Availability of training and support resources
  3. Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation
Materials
Training and Support
Resources
Quality Assurance
Procedures
Overall
Rating
3.0 3.5 4.0 3.5

Dissemination Strengths

The implementation materials are comprehensive and provide information on all aspects of the program, which can be adapted for use by established sites and academic systems. The materials also include information on SAP team roles, team meeting checklists, and descriptions of the nine components that should be included in a substance abuse prevention SAP framework. Two-day, on-site implementation training is available. Ongoing implementation support is available from the developer. The training and implementation manual includes an implementation schedule that outlines the necessary steps for replicating the STARS Nashville SAP with fidelity and includes tools to assess the implementation of the SAP components.

Dissemination Weaknesses

The user-friendliness of the training and implementation manual is hindered by the small font size and lack of organizational tabs. The intended audience of the SAP training is not clearly established. Given the large amount of material in the training participant workbook, it is not clear which materials are essential for program development and implementation and which are ancillary.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description Cost Required by Developer
SAP 101 (manual) $30 each Yes
2-day training of trainers $400 per participant, for up to 40 participants Yes
2-day, on-site implementation training $3,000 plus travel expenses No
On-site technical assistance/consultation $1,000 per day plus travel expenses No
Consultation by phone or email $85 per hour No
Evaluation technical assistance by phone or email $85 per hour No

Additional Information

The average cost for one student to participate in the STARS Nashville SAP, including prevention and intervention services, is $19.24 per year from kindergarten through grade 12. The average cost for one student to participate in one prevention activity or event is $5.44.

Replications

Selected citations are presented below. An asterisk indicates that the document was reviewed for Quality of Research.

Williams, C., Kanu, M., Crawford, G., Fu, D., & Medapally, P. (2004). Sumner County Board of Education community-based 2003-2004 agency report. Memphis, TN: University of Memphis.

Contact Information

To learn more about implementation, contact:
P. Rodger Dinwiddie, M.Ed.
(615) 279-0058
prdinwiddie@starsnashville.org

To learn more about research, contact:
Nancy A. Hepler, Ph.D.
(208) 835-5675
nhepler@yahoo.com

Consider these Questions to Ask (PDF, 54KB) as you explore the possible use of this intervention.

Web Site(s):